{% include 'header.html' %}
<div class="container">
    <div class="jumbotron">
        <h1>你好，{{ session['user_name'] }}，请对日常问题进行反馈!</h1></br>
        <form action="/submit_xuncha" method="post">
            <div class="form-group">
                <label for="exampleInputName">请输入姓名</label>
                <input type="text" name='name' class="form-control" id="exampleInputName"
                       aria-describedby="nameHelp">
                <small id="nameHelp" class="form-text text-muted">姓名提示 ： {{ session['user_name'] }}</small>
            </div>
            <div class="form-group">
                <label for="exampleInputshijian" >时间</label>
                <input type="text" name='shijian' class="form-control" id="exampleInputshijian">

            </div>
            <div class="form-group">
                <label for="exampleInputkeshi">科室</label>
                <input type="text" name='keshi' class="form-control" id="exampleInputkeshi">

            </div>
            <div class="form-group">
                <label for="exampleInputwenti">日常问题反馈</label>
                <input type="text" name='wenti' class="form-control" id="exampleInputwenti">

            </div>

            <button type="submit" class="btn btn-primary">提交</button>
        </form>
    </div>

</div>
{% include 'footer.html' %}






